Breathing treatment (nebulizer)
Facility: Meade District Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $55
- Cash Discount Price: $67
- vs. Medicare Baseline: 0.25x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $223.72 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $55 | 25% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer at Meade District Hospital in Meade, KS, the cash price is $67.00. This facility, a Critical Access Hospital owned by a government hospital district, lists a median negotiated rate of $55.00 for commercial payers, which is lower than the cash price. While the facility's negotiated rate is $55.00, it is important to note that commercial insurance contracts often include administrative layers that can inflate the baseline price by 20% to 40% compared to direct cash payments. For patients with high-deductible plans, paying the cash price of $67.00 upfront may be more cost-effective than relying on insurance, as the negotiated rate could exceed the out-of-pocket costs once deductibles are met.
The Medicare benchmark for this service is $223.72, which serves as a baseline for evaluating the facility's pricing markup. The facility's cash price of $67.00 is significantly lower than the Medicare amount, suggesting a competitive rate structure relative to federal standards. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it is still advisable to request a prompt-pay discount before scheduling. By paying in full within a brief window, patients can potentially reduce the bill by 20% to 50%, bypassing the administrative costs associated with insurance claims processing. Always verify the specific allowed amount with the hospital prior to treatment to ensure you are aware of the exact financial responsibility.